• A direct or indirect lung insult resulting in diffuse alveolar damage • ARDS and acute lung injury (ALI) describe the same clinicopathological process – the difference is merely one of severity
Miscellaneous ITU chest conditions
LUNG TRANSPLANTATION
LUNG TRANSPLANTATION
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ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
DEFINITION
the increased pulmonary microvasculature permeability allows protein-rich fluid to pass into the alveolar spaces at normal hydrostatic pressures
idiopathic pulmonary fibrosis 
sarcoidosis 
lymphangioleiomyomatosis
bronchiectasis
CT chest 
quantitative ventilation–perfusion scintigraphy
causes include interruption of the donor lung lymphatic drainage, underlying donor lung injury, surfactant deficiency and pulmonary capillary ischaemic damage
linear or reticular shadowing is also common 
peak shadowing is seen at day 4 and has usually cleared by day 10 post-op
a lost cough reflex 
impaired mucociliary function (as the transplanted lung is denervated)
Pseudomonas 
Aspergillus
ground-glass opacification 
septal thickening 
multiple or single nodules 
pleural effusions
the majority respond to IV methylprednisolone
it can demonstrate new or persisting airspace opacities 5–10 days following transplantation 
there may be pleural effusions and interstitial lines without other signs of heart failure
ground-glass opacification or septal lines may be the predominant finding
acute allograft rejection 
low cardiac output 
prolonged postoperative ventilation
episodes of acute rejection increase the likelihood of developing OB
there can be signs of lung overinflation and subtle attenuation of the peripheral airways as the disease progresses
air trapping at end expiration 
mosaic perfusion 
bronchiectasis is commonly present
it usually occurs during the 1st year post transplant (affecting 5–20% of patients)
a diminished pulmonary compliance 
normal pulmonary capillary wedge pressures
